By Michael R. Cohen, R.Ph.
A woman reported an error to us after her child’s doctor sent an electronic prescription to a community pharmacy for her 11-year-old daughter. The prescription was for the laxative Miralax powder (polyethylene glycol 3350). The woman was told by her doctor to give her daughter 3 teaspoonfuls by mouth mixed with 6 ounces of liquid. This was to be taken once a day for 30 days. However, when the woman picked up the prescription, the label on the bottle said take three tablespoonfuls mixedwith 6 ounces of liquid daily for 30 days. That might have led to a pretty serious error. Except for one thing – an important new type of back-up system came into play.
Although the doctor sent the prescription to the pharmacy electronically, he gave the woman a hard copy of the prescription in case there was a problem. Smart move! In the past, you got a hand written prescription, where at least you could usually make out the drug name. But with e-prescribing, you may not be given anything in writing and you may not know what to expect at the pharmacy. If the pharmacist hands you something that doesn’t seem right based on your expectations, then it might just be that an error has happened. In this case though, the woman told us that the hard copy saved an error. She said she would not have remembered the correct dose if she had not received the copy of the prescription. So she would have given her daughter more than the required dose for her age and weight.
You should always receive verbal instructions from your doctor about how to take your medicines. This will give you an opportunity to ask questions. But if the prescription is sent electronically to the pharmacy, you should also be provided with a clearly marked copy or corresponding “voucher.” Insist on it. This voucher should list the medicine that was ordered, the dose, and the directions for use. You can use the voucher to check the prescription by matching it to what you actually receive in the pharmacy to assure it is the correct medicine and instructions.
Thanks to federal incentive payments to doctors and health professionals who “ePrescribe” for Medicare patients seen in their offices, handwritten prescriptions are quickly becoming a thing of the past. In fact, about 60% of office based physicians now prescribe electronically.
Electronic prescribing helps prevent medication errors by pharmacists and others when reading or trying to understand handwritten prescriptions and medical records. It also helps to reduce adverse drug events by helping prescribers recognize drug interactions and contraindications when selecting medications by computer. But the ability to use a prescription voucher to prevent errors is an added bonus that shouldn’t be overlooked by patients and caregivers.